AME (awareness, motivation, engagement)

Ask them if they’d be willing to do a 2-minute questionnaire that looks at the way alcohol and other drugs may be affecting their lives. Explain that it’s just a tool that can make the process easier. Offer to answer any questions they might have before completing the questionnaire. For example, you could say:

“Our job is to get you through this supervision order and support your general health and well-being. I want to help you be successful in both completing your order and meeting your own goals. One of the things that often gets in the way of doing that is a person’s substance use. What I’d like to do is go through a brief (10 questions) screening tool with you to see if substance use is something that might be getting in your way. It’ll help both of us get a better understanding of whether or not this is something we want to work on during our time together.”

The questionnaire may have brought up sensitive issues or questions, so it’s important to ask how they felt filling it out. You can either address the issues on the spot or jot them down for later. Here are some sample conversations:

YPO: So, how was it?
Youth: Not so bad. Guess it helps me see what I need to change.
YPO: Let’s see what your score is.
Youth: Whatever.

YPO: So, how was that? How do you think the information might be useful?
Youth: It’s just the same old stuff.
YPO: I can see why you might think that, but let’s see what shows up when we score it.

YPO: Sometimes people learn surprising things as they complete a questionnaire. What were your reactions to the questions?
Youth: I guess I felt…

The first part of the Difficulties and functioning screen is comprised of 10 questions. A youth’s final score can be anywhere from 0 to 20. (‘Not true’ items are scored as 0, ‘somewhat true’ items are 1, and ‘certainly true’ items are 2.) Overall scores of 2 or more suggest the young person could benefit from brief intervention.

Explain how the scoring system works and then sit beside them to go over the questionnaire. (The more involved they get in what is a fairly non-threatening process, the more comfortable they’ll be with tougher tasks later on.)

When giving feedback about a score, be sure to refer to the actual items on the screen that raise concern. And remember that feedback should be personally relevant and resonate with concerns the youth might have about their drug use. (Lecturing them about a behaviour that only you find concerning isn’t likely to be helpful.)

Start by focusing briefly on any positive behaviour related to their drug use. For example, if they tell you they drink alcohol with their friends, you could mention that it’s good to hear they’re not drinking alone as doing so can suggest they’re in the process of developing a problem. If there’s little to be positive about, praise them for their honesty in answering the questions.

Use a motivational interviewing style when walking through the results. Let the young person form their own conclusions, but help them along by asking, "What do you make of this?" or "How do you feel about this?" You can also watch for non-verbal cues such as scowls, frowns or even tears. Reflect on these cues with statements such as, "I guess this must be difficult for you to accept because it confirms what your mom has been saying" or "I can see you are having a hard time believing all this."

Here’s a sample conversation using positive feedback and motivational interviewing techniques:

YPO: Thanks for filling out the questionnaire. Why don’t we score it together?
Youth: Okay.
YPO: So, you have a score of 3, which suggests that you’re having some trouble because of your substance use. But I see here that you don’t drive or ride with others under the influence of alcohol or other drugs. That’s very responsible of you. I’m glad to see you’re doing things to keep yourself safe.
Youth: I don’t want to get into an accident. I know a few people who’ve been hurt.
YPO: That’s a really smart decision. Car accidents are the leading cause of death among people your age. But you did note that you sometimes get into trouble when you’re using drugs. Tell me something about that...

What comes next depends to some extent on their score on the screen.

If they’ve scored below 2, support their positive behaviour by saying something like:

“At this point, you don’t seem to be having any major difficulties related to using alcohol or other drugs. Good for you! I encourage you to continue to be very careful when it comes to using substances. Do you have any questions about alcohol or other drugs? Or would you like any information on the drugs you’ve tried? If you ever have any concerns, I’ll be glad to discuss them. Be sure to keep up the good work.”

If they’ve scored 2 or more on the Difficulties and functioning screen, use brief intervention techniques to begin the process of delving more deeply into why they’re using drugs. Here’s an example of a conversation with a youth with a score of 4.

YPO: At this point, it appears that you’re experiencing some difficulties with your drug use. We’ve talked a bit about these problems today, but perhaps we can talk more later on and try to find a way to reduce the harm you’re experiencing, okay?
Youth: Why?
YPO: Well, my goal is to help you complete your order successfully and keep you safe. Talking about some of your concerns around your drug use may help us to do this, but it’ll be your decision as to how far we go with this and what you choose to do with the information. I’d really like it if we could spend a little more time talking about this next time.

Tip: By tailoring your intervention to the unique needs of each young person, you can be more efficient and more effective. For more details, you can access the brief intervention material on the "Where it goes" tab.

Your first goal is to explore their perceptions of their substance use and look for signs that they may be willing to make a change. You can help draw out this “change talk” by referring to some of the issues that came up during the AME screening process.

To find out how they feel about the benefits and costs of their drug use, you can simply ask them, “What are some of the good things about using drugs?” and “What are some of the not-so-good things about drugs?” Or you could use a tool such as Good and not-so-good.

Tip: Devote some time to talking about their strengths as doing so can help them identify and explore any gaps between their current substance use behaviour and their personal values and goals. One way to start the process is to use the Strength meter.

To find out what their goals are, simply ask them, "What things are most important to you?" or "How would you like your life to be different five years from now?" or even "What would you like to have happen during our time together?” Or you could use All about me as a way to get them talking.

Here’s an example of how the conversation might play out:

YPO: You said that one of your goals is to get a job as a mechanic because you really enjoy working on cars.
Youth: Yeah. Being a mechanic would be really cool.
YPO: So, what do you need to do to become a mechanic?
Youth: I don’t know. I haven’t really looked into it. I guess I’ll need to go to college for a while.
YPO: And how ready are you to go to college?
Youth: Well, I haven’t finished high school yet, so I need to do that first.
YPO: How’s high school going?
Youth: Not so good.
YPO: How come?
Youth: I’m suspended right now because I was drinking on school property.
YPO: So drinking got you kicked out of school. How do you think that could affect your going to college and becoming a mechanic?
Youth: I guess if I don’t get back in and get pretty good grades, I won’t get into college.
YPO: Let’s think about how we can help you do that.

Note: If the young person tends to minimize their alcohol or other drug use, you might use the Substance use behaviour screen to help them take a careful look at their substance use.

At this point, you may have a good idea of whether or not the young person is ready to change their drug use patterns. Still, it’s important to ask them directly about their current level of motivation. You can do this using one or more of the change scales in Let's talk about change, which lets youth self-report their intention to change their behaviour on a scale of 0 to 10. This will help them move towards making a decision, and offer you direction in terms of where to go from here.

The change scales can be used to start a discussion about both the importance of change and the young person’s confidence in making the change. First, help them determine what they might like to change based on something they mentioned earlier, or by asking them directly. Then ask them to circle the number on the change scale that best describes how they feel right now. Here’s how the conversation might go:

YPO: Based on what you were telling me earlier, it seems that you’d like to reduce the school problems that you’re having as a result of your drug use. Is that right?
Youth: Yeah. I mean it would be great if I didn’t get into trouble so much.
YPO: On a scale of 0-10, with 0 being not at all and 10 being very high, how important is it for you to stop using substances at or before school?
Youth: I guess about a 6.
YPO: Okay, that sounds like it’s pretty important right now. Why a 6 and not lower?

You can then repeat the process to explore their confidence in their ability to make the change.

The third scale (readiness) is usually a factor of importance and confidence so it may not be needed unless the young person indicates both high importance and high confidence but still seems reluctant to attempt change.

If the young person indicates a low score on the importance scale, the goal of your brief intervention will likely be to help them increase their motivation to make changes to their drug use pattern. Here’s an example of how the conversation might go:

YPO: On a scale of 0 to 10, how important is it for you to make this change?
Youth: I’d say about a 2.
YPO: OK. So it’s not that important for you right now. How will you know when it is time to start thinking about a change?

Tip: You can access more material on the "Next steps" tab.

If the young person scores in the middle or high on the importance scale, the goal of your brief intervention will likely be to facilitate change. Here’s what you might say in such cases:

YPO: On a scale of 0 to 10, how important is it for you to make this change?
Youth: I’d say a 5.
YPO: Okay, in the middle. So you think it might be important. But I am wondering why you said 5 and not lower. What’s one of the reasons it’s important?

Tip: You can access more material on the "Next steps" tab.

Note: If the youth seems to be wavering back and forth between thinking about changing and not changing, try using the Continue versus change worksheet to help them weigh the costs and benefits of changing.

Supporting positive behaviour includes raising a young person’s awareness of their developing strengths and the role these can play in their health and well-being.

If a young person scores below 2 on the Difficulties and functioning screen, chances are they’re at minimal risk of having an issue with alcohol or other drugs. But they may still require support for their positive behaviour and healthy lifestyle choices.

Youth who score 2 or more on the Difficulties and functioning screen are at greater risk of developing drug-related problems and perhaps need even more recognition for the good choices they’re making, even if for now the only good choice has been in showing up for their meeting with you.

Note: Pointing out their strengths doesn’t mean ignoring the risks related to their weaker moments. Instead, it helps you build a deeper bond with the youth and lays the groundwork for later discussions about potential changes they could make. In short, your role is to help them both see their strengths and use them to build motivation, confidence and self-efficacy for changing any problematic drug use behaviour.

Some young people may be disinterested in or resistant to making changes to their use of alcohol and other drugs. They may be partly or even completely unaware that a problem exists, that they should make changes, and that they may need help to get there. They may have never considered the potentially harmful consequences of their drug use. Or they may see themselves using drugs in the same way as everyone around them and not feel particularly concerned about the risks.

It can be challenging to convince youth in this situation that their drug use can be harmful because they may not have experienced any negative consequences yet and therefore won’t believe you. The first step in helping them is to figure out why they’re not open to change.

Typically, there are four types of resistance:

• • Reluctance results from a lack of sufficient knowledge about the dimensions of the problem—or the personal impact it can have—to think change is necessary. Reluctant youth are most likely to respond to sensitive feedback about how their drug use is affecting their lives.
  • Rebellion often results from a fear of losing control over one's life and having a large investment in the drug(s) of choice. Your challenge is to help young people in this situation shift this energy into making more positive choices rather than rebelling against what they perceive as coercion. Emphasizing their personal control can work well with this type of youth.
  • Resignation comes with a feeling of hopelessness about change and being overwhelmed by the energy it may require. Youth in this situation have probably been in treatment before or have tried repeatedly to change on their own but haven’t been successful. These youth need to regain hope and optimism about their capacity for change. This can sometimes be accomplished by exploring specific barriers that impede new beginnings.
  • Rationalization involves having all the answers. These youth may understand drug use is a problem for others but not for themselves because the odds are against their being at risk. Reflection, rather than reason-based argument, seems to work best with youth in this situation. That is, acknowledge what they say, but remind them of issues they brought up earlier about the potential downsides of their use.

Tip: With youth who are not currently open to change, using terms such as “problem," “substance abuse” or “denial” is more likely to inflame their resistance than increase their motivation to overcome it. Instead, focus on language that builds rapport and encourages them to question their own beliefs about the harmlessness of their drug use patterns.

When we talk about youth who are receptive to changing their drug use behaviour, we’re talking about two distinct types: (1) youth who are ambivalent about change, or who are committed to change but aren’t sure how to, and (2) youth who may be somewhat ambivalent but who know change is necessary and are already actively trying to change.

When working with youth contemplating change, your aim is to help them see that change is worthwhile and that they’re capable of doing it. When working with youth actively engaged in trying to change, your aim is to provide encouragement and support to help them stick with their decision.

Brief intervention for youth in either of these situations should include

• • cementing their decision to change
  • enhancing their confidence in their ability to change
  • helping them plan realistic change

Relapse prevention involves helping a young person develop skills to continue their health-promoting behaviours while avoiding their old patterns of harmful behaviour related to using alcohol or other drugs.

Note: Behaviour change isn’t linear. Moving back and forth between various levels of motivation should be seen as a normal part of the change process. In other words, it’s normal for the young people you work with to have lapses in motivation and behaviour change.

Relapse prevention should be seen as a part of the change process and a normative and essential component of brief intervention. Following any intervention, you should check in with the youth to monitor their progress since the last session, and to try to help them

• • identify any barriers to their progress
  • reinforce self-efficacy and skills
  • strategize about where to go from there

It’s important to keep in mind that you may need to repeat the steps of your brief intervention several times before seeing significant progress in the youth’s behaviour. It may also be helpful to reuse some of the worksheets and techniques you’ve been using to support their positive behaviour, such as My change plan, Strength meter and Identifying and dealing with high-risk situations.

Tip: You may want to go outside the traditional helper role and suggest some faith-based ways for them to tunnel through the “stuff” in the outside world that’s getting in their way of success. For some youth, simply understanding that they are loved by something bigger than themselves (and bigger than anyone they know) may give them the comfort and confidence they need to get back on track.